Pharmacologically Treated Anxiety and Depression in People Diagnosed with von Willebrand Disease: Matched Cohort Study

Abstract

Background

People diagnosed with von Willebrand disease (VWD) have reduced quality of life versus the general population, and there is limited evidence of increased rates of anxiety and/or depression among people diagnosed with VWD.

Aim

To understand the association between VWD and mental health outcomes.

Design and Setting

A retrospective cohort study was conducted using the UK Clinical Practice Research Datalink (CPRD) GOLD database (1988–2016).

Methods

People diagnosed with VWD were matched 1:10 to randomly selected people in the database without VWD based on sex, birth year ±2 years, CPRD record start year ±2 years, and general practice attended. Individuals were followed from VWD diagnosis or match date to censoring (first event date, CPRD end date, or death). Treated anxiety and treated depression were identified by a diagnostic Read Code and a prescription for anxiety/depression medication recorded within 90 days of each other, after VWD diagnosis/match date.

Results

Treated anxiety was recorded in 89 of 1119 (8.0%) people diagnosed with VWD and 624 of 10,423 (6.0%) without VWD (age- and sex-adjusted incidence rate ratio [IRR], 1.37; 95% confidence interval [CI], 1.10–1.71). Treated depression was recorded in 119 of 1083 (11.0%) people diagnosed with VWD and 846 of 9845 (8.6%) without VWD (adjusted IRR, 1.35; 95% CI, 1.11–1.63). Females aged 20–39 and 0–19 years were at greatest risk for treated anxiety and treated depression, respectively.

Conclusion

Higher rates of treated anxiety and depression were observed among people diagnosed with versus without VWD, predominantly in young females.

Keywords:

• anxiety
• depression
• general practice
• mental health
• von Willebrand disease

Abbreviations

CI, confidence interval; CPRD, Clinical Practice Research Datalink; GP, general practitioner; IR, incidence rate; IRR, incidence rate ratio; PY, patient-years; VWD, von Willebrand disease.

Ethical Review and Data Sharing Statement

This study is based on data from the CPRD obtained under license from the UK Medicines and Healthcare products Regulatory Agency. The data are provided by patients and collected by the UK National Health Service (NHS) as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone. This study was approved by the Independent Scientific Advisory Committee (ISAC) for Medicines and Healthcare products Regulatory Agency database research, and the protocol was made available to the journal reviewers upon request (protocol No: 17_242R2A, Hospital Episode Statistics (HES) Copyright^© [2018], reused with permission of The Health & Social Care Information Centre. All rights reserved). Researchers can apply for a limited license to access CPRD data for public health research, subject to individual research protocols meeting CPRD data governance requirements. More details, including data specifications, license fees, and the application process, are available on the CPRD website (https://www.cprd.com).

Acknowledgments

Statistical analysis support was provided by Rebecca Persson, MPH, epidemiologist at Boston Collaborative Drug Surveillance Program (Lexington, MA, USA). The authors would like to thank Françoise Truong Berthoz from Takeda Pharmaceuticals International AG, Zurich, Switzerland, and Spiros Tzivelekis from Takeda Development Center Americas, Inc., Cambridge, MA, USA, for their contributions to the study design. Under the direction of the authors, medical writing support was provided by Joanne Vaughan, BSc, employee of Excel Medical Affairs (Fairfield, CT, USA) and was funded by Takeda Development Center Americas, Inc., Lexington, MA, USA.

Data contained within this article were presented in part at the World Federation of Hemophilia Congress; May 8–11, 2022.¹⁹

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

KWH and SJ have received grant/research support from Baxalta US Inc., a Takeda company, Lexington, MA, USA. GÖ is an employee of Takeda Development Center Americas, Inc., Cambridge, MA, USA, and is a Takeda stockholder. PD was an employee of Takeda Development Center Americas, Inc., Cambridge, MA, USA, at time of study. The authors report no other conflicts of interest in this work.

Additional information

Funding

This study was funded by Baxalta US Inc., a Takeda company, Lexington, MA, USA. The sponsor was involved with the study design, interpretation of findings, report development, and in the decision to submit the article for publication.